What Do You Say in Therapy?

One of the most common questions I hear from clients is, “What do you say in therapy?” It’s a simple and fundamental question, but one with many different answers depending on the style and the depth of analysis. I’ll give you an example. One client asked me, “Do you use an acceptance perspective in your writing?” I responded, “Most of my writing, although it’s therapy, I come off as highly objective and logical.”

Another client said, “I get frustrated by therapists who say, ‘Your thinking is so obvious,’ ‘You’re so ungrounded in reality,’ ‘You can’t see yourself objectively.’ You’re not grounded in reality, but what you think is reality. That’s why I’m calling you an expert, because I don’t think in terms of what you call reality. I just think from a straight objective standpoint-from the truth.” A third client said, “I feel that when therapists tell me, ‘you’re wrong’ or ‘you have an obsession,’ that leads to a sense of helplessness and even depression, and that’s not healthy.”

The answer to the question “what do you say in therapy?” can change based on the style and the depth of the analysis. In a cognitive model, you might respond, “I notice that you’re frustrated and angry that you’re making this kind of mistake.” Or “You’re defensive when you point out that your spouse’s acting out of control.” A verbal model might be, “So, let me ask you… did you notice that when this situation occurred, did you… did you try to work out the problem, or did you just lie about it?”

Or you could start by describing the event and then discussing how you felt and what you thought. “So, how was your mood before you had this conversation?” “And were you angry, irritated, or resentful?” This is a great way to begin.

As you progress, you can add other questions to the dialogue. “So, now that you’ve asked me a couple of questions, what do you think you need to do next? Would you like to grab a trash can or a hanger? Would you like to speak with a professional?” These are all good ways to get your clients talking and participating.

In my experience, clients who hear themselves talk through their problems and fears usually find resolution. If they don’t feel heard, they may shut down hard. When someone hears themselves talk through their problem and their fears, their “bounce back” response helps them to resolve. They are not angry, they are disappointed–they know there is a problem and that they need help.

So, the next question is, “How will you help a client figure out how to talk about this with others?” The first step is for the client to share their feelings, thoughts, and worries with a trusted friend/clan/therapist. It is often easier if the client already knows someone they can open up to. It may be someone who they have already seen or spoken with in some other setting.

Next, the therapist needs to understand the reasons behind the thoughts, emotions, and feelings the client has. This is where listening skills come into play! As you listen to clients describe their feelings, problems, and fears, you are providing them with a map to walk through their feelings and their fears. Sometimes it is easier to start a client in an environment they have already been in, rather than starting them from scratch. So, when you are asking the question “what do you say in therapy?”

After the initial introduction, the therapist will give the client the information they need to create a safe space. Often the first person to say, “What do you say in therapy?” is the one who is most connected with the client. This person can offer the client a safe place to engage with the person they are talking with. The client could ask the therapist what do you say in therapy, but the therapist can respond, “I would like to hear your response” or “You tell me.”

When a client is not sure what to say, there are a few things that help. In order for clients to be able to connect with the person who is talking to them, the therapist and client need to go back and repeat the same statements that they made when they first met. Even though this may sound silly, clients need to hear that they are loved and respected. Asking the therapist “what do you say in therapy?”

What do you say in therapy? Therapy is a collaborative process, and when clients are willing to work with their therapist, the process is enhanced. Asking the right questions during a therapy session can mean connecting with the person who is talking to them and creating a connection. It also means saying “I’m sorry,” “I’m frustrated,” “I don’t understand” or “I don’t agree with you.”